Bouchra Fakhir
Marrakech. Cadi Ayyad University, Marrakech, MoroccoTitle: Conservative management of 23 cases of acreta in university hospital Mohamed the VI in Marrakesh, Morocco
Abstract
Introduction:
Placenta
accreta is no longer a rare condition in obstetrics; its incidence has been
increasing in recent years. It is a placental insertion abnormality that
consists of abnormal adherence of the placenta to the myometrium and carries a
high risk of hemorrhage during delivery. In addition, it requires an antenatal
diagnosis in order to decrease the risk of maternal and neonatal morbidity as
well as mortality.
Patient and
Methods:
Our work is
a retrospective study conducted over a period of 07 years from January 01, 2012
to December 31, 2018, concerns cases of placenta accreta collected at the
Mohammed VI University Hospital in Marrakech, within the Department of
Obstetrics and Gynecology. The objective of our work is to report the
experience of the service with a study of the epidemiological, diagnosis,
therapeutic and prognosis profile of the cases of placenta accreta treated in
this department.
Results:
The mean age
of our patients was 34.7 years [23-42 years], the frequency was estimated at
about 2.17/10000 deliveries (0.02%), the risk factors were represented by a
scarred uterus in 89% of our patients (only one primiparous), curettage in 4
(22.22%) of our patients and placenta previa in 88.89% of cases. The clinical
manifestations were third trimester metrorrhagia in seven (39%) patients, 2
(11%) were in labor and one was admitted for threatened preterm delivery. The
remaining cases were asymptomatic. The antenatal diagnosis of placenta accreta
consisted of MRI-confirmed ultrasonography in 7 cases and ultrasonography alone
in 3 cases, with indicator signs including interruption of the hypoechoic
uteroplacental surface, presence of intraplacental lacunae, and turbulent flow
in the Doppler gap, among others. The histology study showed 1 placenta accreta
and 1 placenta increta in the 2 cases where the pathology result was mentioned.
The mean gestational age was 37.7SA. Conservative treatment was successful in
10 cases (55.56%) compared with 8 (44.44%) who underwent hysterectomy; 3 cases
underwent hysterectomy immediately and 5 cases underwent hysterectomy after
failure of conservative Placenta accreta à propos de 23 cas au sein du service
gynéco-obstétrique du CHU Mohammed VI de Marrakech 79 treatment. However, both
types of treatment were not without complications, mainly infectious for
conservative treatment and haemorrhagic for radical treatment, and only one
case of death by DIC in a context of pre-eclampsia after hysterectomy.
Conclusion:
Placenta
accreta is no longer a rare condition. Antenatal screening is intended for
high-risk patients. Conservative treatment preserving subsequent fertility
would be preferred to radical treatment given the associated morbidity and
mortality except in rare cases due to the increased risk of hemorrhage.
Biography
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